Football & Concussion: Worth the Risk?


By Linda Hepler, BSN, RN

According to a recent Harris Poll, football continues its long reign as America’s most popular sport. From pre-game tailgating to the actual event, where any team can win any week, to post-game celebration parties, and of course, the Super Bowl – one of the most-watched television programs in the country – what’s not to love?

Yet despite its popularity, there is increasing concern and controversy about the long-term safety of playing football, which has resulted in many parents deciding not to allow their kids to participate in the game. In fact, a recent Bloomberg Politics poll found that half of all Americans say they wouldn’t want their child to play football.

The biggest concern? Head injury. According to, concussion rates for children under age 19 who play tackle football have doubled over the last decade, most occurring during practices. Concussions can occur with a blow to the head through helmet to helmet contact, and if undiagnosed and left untreated can lead to permanent brain damage. What is more, “subconcussive hits,” or repeated blows to the head that don’t result in concussions can, over a long period of time, have long term health effects, too – primarily chronic traumatic encephalopathy (CTE), a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma.

CTE caused by repetitive blows to the head as a result of playing football was brought to light in 2002 by Bennet Omalu, a Nigerian-American physician and forensic pathologist, who discovered the condition during an autopsy of former Pittsburgh Steelers player Mike Webster. This finding, as well as his subsequent reports of CTE in other deceased NFL players, eventually led to the book and later the 2015 film, “Concussion.”

It also spurred increasing concern about whether children should be playing football at all. If you were to ask Omalu, the answer would be no. In a 2015 “The New York Times” editorial piece he wrote: “If a child who plays football is subjected to advanced radiological and neurocognitive studies during the season and several months after the season, there can be evidence of brain damage at the cellular level of brain functioning, even if there were no documented concussions or reported symptoms. If that child continues to play over many seasons, these cellular injuries accumulate to cause irreversible brain damage, which we know now by the name chronic traumatic encephalopathy…”

But many sports medicine physicians, like Kristin Ernest, MD, who practices at Texas Children’s Hospital the Woodlands, are less adamant about banning youth tackle football. “There is no conclusive evidence that shows us children shouldn’t play football,” she claimed. “But they should be taught proper technique, and they should have proper fitting equipment.”

Jonathan Minor, MD, a pediatric sports medicine specialist on the concussion management team at CHOC hospital in California, agreed that we don’t know whether there’s a cumulative effect of head injury in football beginning in childhood. But he does believe that such injuries may be prevented by introducing kids first to non-impact football, allowing them to develop skills before playing the contact game. He also advocates core strengthening exercises as a part of football practice. “There is some research showing that core and neck strengthening can help to prevent traumatic brain injury during football,” he said.


And the American Academy of Pediatrics (AAP), while endorsing efforts to limit contact practices in youth football, recently refused to support those calling for an outright ban on tackling in football for athletes below age 18, saying that it is unwilling to recommend such a fundamental change in the way the game is played.

The bottom line is that it’s up to parents to decide whether the risks of youth tackle football outweigh the recreational benefit. Some things to consider for kids who do play football:

  1. Learn the youth concussion laws in your state. While all states now have laws designed to reduce risk of concussion and other head injuries in youth football, not all state laws are equal, according to USA Football. Fewer than half contain all of the key principles, such as limits on full contact practice, mandatory education about concussion symptoms for coaches, removal of a player from the game if a head injury is suspected, and written medical clearance for return to play. Only a handful of laws specify which ages/grades are covered and whether the law pertains to public and private schools and athletic leagues. Worse yet, almost all lack consequences for schools or leagues that don’t comply with the law. Find your state laws on and make sure they are being followed.
  2. Make sure your child is being taught “heads up” tackle technique, advised Dr. Ernest. This USA-designed program utilizes five fundamentals through a series of drills to reinforce proper tackling mechanics and teaches players to focus on reducing helmet contact. Research presented at the American Academy of Pediatrics’ recent meeting in Washington D.C. showed that limits on full-contact practice as well as teaching Heads Up tackling are working to reduce concussion risk in youth football.
  3. Consider a baseline neurocognitive test, such as ImPACT testing, for your child prior to the football season, even if it’s not required by your child’s coach, said Dr. Minor. “A neurocognitive test is a computer-based 20-30 minute test that measures brain functions like visual and verbal memory and reaction time,” he explained. “It’s very helpful to do at the beginning of the season and then repeat if there are signs of concussion. It can help, along with medical evaluation, to make a diagnosis.”
  4. Make sure your child is fitted properly with protective equipment and wears it all the time.
  5. Know the symptoms of concussion – and make sure your child knows them, too. He should know that it’s important to report any of these symptoms to the coach and to you and that he should be removed from the practice or game immediately. A child who is suspected to have a concussion should see a licensed health professional as soon as possible.
  6. Follow the doctor’s orders exactly if your child has a concussion, said Dr. Ernest. Failure to follow orders for physical and cognitive rest can prolong recovery. And know that those who have a first concussion are 3-6 times more likely to suffer another concussion than an athlete who has not had a concussion. So returning to play before the brain has fully healed can put your athlete at higher risk for complications if a second concussion is sustained.


  • WHAT IT IS: According to sports medicine physician Kristin Ernest, MD, a concussion is any force transmitted to the brain itself. While it generally occurs with a blow to the head, any injury that causes the brain to shift rapidly within the skull (such as a whiplash injury) can cause a concussion.
  • SYMPTOMS OF CONCUSSION: While symptoms can vary from child to child, said Dr. Ernest, some of the most common are headache, nausea, dizziness, irritability or crying, trouble concentrating, and sleep disturbance (sleeping more or less than usual).
  • HOW IT’S DIAGNOSED: A concussion will not show up on imaging tests, such as MRI, said Dr. Ernest. It is diagnosed through medical evaluation of symptoms and often, neurocognitive testing.
  • HOW CONCUSSIONS ARE TREATED: Concussions are treated with both physical and cognitive rest, according to Dr. Ernest. This includes rest from all athletic activities, as well as from homework and screen time. In general, recovery takes about 7-10 days, longer for younger children and for those with a history of migraine or ADHD. MS&F